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Liposomal Bupivacaine Decreases Postoperative Length of Stay and Opioid Use in Patients Undergoing Radical Cystectomy.
- Source :
-
Urology [Urology] 2021 Mar; Vol. 149, pp. 168-173. Date of Electronic Publication: 2020 Dec 03. - Publication Year :
- 2021
-
Abstract
- Objective: To analyze differences in length of stay, opioid use, and other perioperative outcomes in patients undergoing radical cystectomy with urinary diversion who received either liposomal bupivacaine (LB) or epidural analgesia.<br />Methods: This was a single center, retrospective cohort study of patients undergoing open radical cystectomy with urinary diversion from 2015-2019 in the early recovery after surgery (ERAS) pathway. Patients received either LB or epidural catheter analgesia for post-operative pain control. LB was injected at the time of fascial closure to provide up to 72 hours of local analgesia. The primary outcome was post-operative length of stay. Secondary outcomes were post-operative opioid use, time to solid food, time to ambulation, and direct hospitalization costs. Multivariable Cox proportional hazards regression was used to determine associations between analgesia type and discharge.<br />Results: LB use was independently associated with shorter post-operative length of stay compared to epidural use (median (IQR) 4.9 days (3.9-5.8) vs 5.9 days (4.9-7.9), P<.001), less total opioid use (mean 188.3 vs 612.2 OME, P <.001), earlier diet advancement (mean 1.6 vs 2.4 days, P <.001), and decreased overall direct costs ($23,188 vs $29,628, P <.001). 45% of patients who received LB were opioid-free after surgery, none in the epidural group. On multivariable Cox proportional hazards regression modeling, LB use was independently associated with earlier discharge (HR 2.1, IQR 1.0-4.5).<br />Conclusion: Use of LB in open radical cystectomy is associated with reduced LOS, less opioid exposure, and earlier diet advancement.<br /> (Copyright © 2020 Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Analgesia, Epidural statistics & numerical data
Female
Humans
Length of Stay statistics & numerical data
Male
Middle Aged
Opioid-Related Disorders prevention & control
Pain Management methods
Pain Management statistics & numerical data
Pain Measurement statistics & numerical data
Pain, Postoperative diagnosis
Pain, Postoperative etiology
Retrospective Studies
Treatment Outcome
Urinary Diversion adverse effects
Urinary Diversion methods
Analgesics, Opioid adverse effects
Anesthetics, Local therapeutic use
Bupivacaine therapeutic use
Cystectomy adverse effects
Pain, Postoperative drug therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1527-9995
- Volume :
- 149
- Database :
- MEDLINE
- Journal :
- Urology
- Publication Type :
- Academic Journal
- Accession number :
- 33278460
- Full Text :
- https://doi.org/10.1016/j.urology.2020.11.036